August 10, 2007

Council on Chiropractic Guidelines and Practice Parameters Announces Release of Additional Components to the Chiropractic Compass

Fifteen months after the release of the first draft of the low back evidence stratification for public comment, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is poised to release additional components of the Chiropractic Clinical Compass beginning immediately with the Preface, a revised Introduction, and a newly created chapter on Methodology. Each of these three sections will be available for review on the CCGPP website next week at www.ccgpp.org. 

The next draft of evidence stratification scheduled for release for public comment is Wellness, Non-musculoskeletal and Special Populations, which will be posted at www.ccgpp.org on September 1. CCGPP anticipates the release of one additional draft approximately every 30 days beginning with "Upper Extremity Conditions" on October 1 followed by Low Back Part A, Cervical Spine, Soft Tissue, Thoracic Spine, and Lower Extremities.  As was done previously, drafts will be posted on the CCGPP website (www.CCGPP.org) for 60 days of comment. Notification of each release and instructions for submitting comments will be distributed to stakeholders prior to posting via traditional communication outlets. Interested constituent members are urged to organize review efforts now.

A previous draft of the low back evidence stratification released for public comment a year ago was the subject of a significant amount of very helpful feedback, much of which was discussed and worked through in a constructive session with stakeholders at the  Congress of Chiropractic State Associations annual meeting in Baltimore last November. Based on suggestions received, the low back team has elected to perform a more comprehensive review of the literature pertaining to diagnostic issues, which will further delay re-release of portions of the low back chapter. Over 600 comments have been received, reviewed and addressed, using methodology similar to that used to address public comments to statutory or workers' compensation regulations in states like Texas.  Similar comments were collapsed and addressed with one of three possible responses:
1. agreement with the criticism and appropriate revision of the document
2. no response, when no supporting evidence was provided for the critique
3. disagreement with the criticism, with rationale for the disagreement

A large number of urgent requests have been voiced by the profession for high quality evidence of efficacy to support care, particularly in addressing third party payor denials and to assist with regulatory hearings. The literature review to date demonstrates excellent quality of literature support for the primary chiropractic treatment approaches to low back pain, which are unlikely to be changed by review of additional literature at this time; therefore the commission has elected to re-release the low back chapter in two parts.  Part A will consist of treatment approaches and other aspects which generated little or no comment. Part B, which will consist of diagnostics and related issues, will be deferred pending additional literature review and synthesis.

A new chapter concerning the vertebral subluxation has been commissioned by the Association of Chiropractic Colleges.  A committee, headed by Drs. Carl Cleveland III and Meridel Gatterman and comprised of content experts from the various colleges, has been charged with developing the chapter following CCGPP methodology, which is outlined in the introduction.

In keeping with the agreements reached with COCSA members in Baltimore last year, the recommendations of constituents have been revisited and addressed. Among other suggestions was the need to improve formatting, and to that end professional assistance has been retained to make the document more readable and user friendly. The Council is quick to point out, however, that editing is for the purpose of clarity and readability and not for any content or conclusion edits.

The Council is pleased to announce the appointment of Cheryl Hawk, DC, PhD, of Cleveland Chiropractic College, as new Chair of the CCGPP Research Commission.
Dr. Hawk is currently Vice President of Research and Scholarship at Cleveland Chiropractic College. She is a 1976 graduate of National College of Chiropractic and practiced full-time for 12 years. In 1991, she earned a PhD in Preventive Medicine from the University of Iowa and also became a Certified Health Education Specialist (CHES). She has been the primary writer of successful grant and contract proposals totaling over $5 million. She is also an author on over 60 peer-reviewed articles and book chapters. Currently Dr. Hawk serves on the ACA Wellness Campaign Committee and as the CCGPP Team Leader for "Wellness, Non-musculoskeletal Conditions and Special Populations." From 2003-2006, she served as the appointed chiropractic representative on the National Advisory Committee for Interdisciplinary, Community-Based Linkages of the U.S. Health Resources and Services Administration Bureau of Health Professions. In 2005, she was named "Researcher of the Year" by the Foundation for Chiropractic Education and Research.

 "We are very fortunate to have someone of Dr Hawk's caliber take over the reins.  Dr Hawk brings a fresh perspective, as well as years of clinical experience and research expertise.  We're very excited to have her on board," noted Dr. Whalen.

Dr Hawk replaces outgoing Chair Jay Triano, DC, PhD, who stepped down on the heels of his appointment as professor and Interim Dean of Graduate Education and Research for the Canadian Memorial Chiropractic College. He has also been appointed as Associate Professor in the School of Rehabilitative Science at McMaster University.   Dr. Triano, a biomechanist and formerly a clinician and researcher at the Texas Back Institute, served as CCGPP Research Commission Chair since 2003 and was instrumental in orchestrating the broad and diverse pool of researchers from across the country and internationally who collaborated to review and rate the literature on the various conditions. Simply finding doctors with the special skills necessary for the task, much less convincing them to volunteer hundreds of hours of their time was a Herculean task.  Organizing the massive effort among dozens of clinicians and academic topic volunteer experts was a major undertaking, and now that framework has been established, Dr Triano felt comfortable in turning over the reins.

"While this project has required the collective efforts and sacrifice of dozens of the profession's best and brightest, no one involved would dispute that without the persistence and vision of Dr Triano, the project would ever have made it this far. We all owe Dr Triano a debt of gratitude," noted CCGPP Chairman Dr Wayne Whalen.

Dr. Triano now joins the ranks of prior Research Commission chairs Charles Lantz, D.C., Ph.D., Dana Lawrence, D.C. and William Meeker, D.C., M.P.H., who have all served CCGPP with distinction.  Dr Alan Adams, an expert on literature evaluation, continues to serve as Commission Vice Chair in a primarily advisory role.

Further information, as well as the draft chapters when released, is available at the CCGPP web site (www.ccgpp.org). You may also contact Dr. Whalen at (619) 258-1144 or This e-mail address is being protected from spambots, you need JavaScript enabled to view it , or Janet Jordan, CAE, at 803-808-0640 or  This e-mail address is being protected from spambots, you need JavaScript enabled to view it .